The Pregnancy Series, Part II: The 6-week myth

5 things to consider before resuming exercise and sport after baby

So you’ve had your 6 week checkup after delivering your baby, and your doctor gives you the all-clear to return to exercise. Before you sign up for your local boot camp class, there are a few things to consider in order to get you back to exercise and activity after childbirth.

For starters, your doctor is primarily assessing whether episiotomies, tears or C-section incisions have properly healed and that your pelvic organs have not dropped as a result of pregnancy or delivery. Some doctors may check your ability to contract your pelvic muscles, but this assessment is usually limited to general contraction rather than the ability to coordinate your pelvic floor during movement and exercise. Because your core is an integrated system that includes the respiratory diaphragm, abdominal, pelvic and spinal muscles, the strength, awareness and coordination of all of these components during movement is essential. If you are focusing on crunches, leg lifts and planks without good coordination with the rest of your core, the post- baby tummy may get worse rather than better. That 6-week clearance is a good first step to getting back in shape, but if you notice any of the following signs, you may need some extra help getting back on track.

What to look for: Signs you may need pelvic floor physical therapy to help you return to exercise safely

1. Do you have a diastasis (abdominal separation)?

Women can develop a diastasis rectus during and following pregnancy. The expansion of the uterus into the abdomen during pregnancy can create increased tissue stress that may result in separation of the abdominal wall. Certain movements, heavy loading and straining can further stress the tissue and lead to a larger separation.

Self check:

Lie on your back and place your fingertips over your belly button, palm facing you. Gently lift your head and shoulders off the floor. Repeat this above and below the belly button. Do you feel your fingers sink into your tummy or do the muscles come together as you lift? If the abdominal wall separates more than two fingers in width you have a diastatsis rectus.  The good news is that there are lots of ways to retrain and strengthen your core system safely and without risk of further increasing your diastasis. If you feel like your abdomen has a wide gap, domes with exertion or you’re just unsure about when to resume crunches, sit ups and other core exercises, we can help!

2. Is something ‘falling out’ of your vagina?

Are things falling out when you bend, lift or exercise?

Are things falling out when you bend, lift or exercise?

If so, you may have pelvic organ prolapse, or loss of support of your bladder, bowel and/ or uterus that results in dropping of the organs into or outside of the vagina. It may look something like this:

Pelvic floor muscle strengthening and coordination training with your entire core- abdomen, diaphragm, spine and hips- is essential to prevent further prolapse and help provide support to your organs with everyday activities and exercise. No one wants to lift her baby and have her bladder fall out. If this occurs, it is a sign that the integrated core is not working correctly. In many cases, learning safe exercises and activity modification can retrain the muscle system and stop further stress on your organs.

3. Are you leaking urine or stool when lifting your children or pushing the stroller?


Leaking with exercise?

Have you modified your workout to avoid jumping, running and other high impact activities OR are you living with leakage by wearing a pad during exercise? Bladder and bowel incontinence may result from pelvic floor muscle weakness. Before you start madly doing Kegel exercises, there are other factors related to the system that need to be considered. Coordination, awareness and tissue integrity are other factors that affect pelvic organ support and bladder control. Retraining of the entire core system can help you stay active and dry at the same time.


4. What core muscles?

Are you having a hard time contracting your pelvic or abdominal muscles? If you are holding your breath, bearing down or generally just not sure what you are doing when you do a Kegel or abdominal contraction you may be having difficulty coordinating your core. Further, if you are challenged while lying down, consider what may be happening when you are seated, standing and exercising. Jumping back into your old exercise routine without proper core coordination and strength may put strain on soft tissue and pelvic organs and contribute to prolapse, leakage and the lingering “mommy pooch” in your 40’s, 50’s and 60’s.

5. Still having aches and pains in your pelvis, abdomen, or back?

It is expected that you will have some pain from a healing episiotomy, C-section, or 10 months of carrying a growing baby. However, the pain should gradually improve and once adequate healing has occurred, the pain should not interfere with your daily activities. If you notice that you are having any pain or pressure during or after sex, exercise or toileting it may be a sign that your integrated core system is not optimally functioning. Pelvic health physical therapists can identify which structures need rehabilitation to return your body to its pre-pregnancy state (or better).

It may take some time but is worth the journey!

It may take some time but the journey is worth it!


It’s important to move your body and resume exercise and activity after childbirth! It will likely take longer than 6 weeks to return to all of your prior activities without limitations- and that is okay. The key is to get you there in a healthy way without causing damage to your HEALING body. The good news is that you CAN do it.

Carolina Pelvic Health Center offers a free 30 minute pelvic floor assessment to all patients we treat during pregnancy to identify any needs after your 6-week doctor visit. If you need some help assistance getting started with your exercise program or just aren’t moving in the right direction, contact us or your local pelvic health physical therapist today!